Healthcare Provider Details

I. General information

NPI: 1053595322
Provider Name (Legal Business Name): NICOLE C MCLAUGHLIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1055
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1055
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: